Lecture 5: Radiology of the thorax 1

Question 1

What is a good systematic approach when reading chest xrays?

Answer 1

1. Film correctly marked i.e L/R , names, type etc 2. Peripheral info i.e tubes, wires etc 3. Is film straight (distance b/w clavicles and SP)/ symmetrical/ satisfactory quality? 4. Identify trachea - is it deviated 5. Identify carina - is it splayed? 6. Hilum of lung and cardiac silhouette 7. Increased / decreased lung markings 8. Look at fissures, can you see them? 9. Look at costo-diaphragmatic angles - are they sharp 10. Look for diaphragm 11. Look at ribs/bones

Question 2

Whats the ABCDs of CXR?

Answer 2

A- Airways, Alignment and Adequacy B - Breathing (Lungs and pleural spaces), Bones C - Circulation (Heart, great vessels, mediastinum) D - Diaphragm s - Soft tissues (review, areas, lines and tubes)

Question 3

What is the silhouette sign on a film?

Answer 3

• Loss of normal lung / soft tissue interface caused by a mass or fluid in the normally air filled space - If the opacity is in contact with the tissue then the border will be obscured, non-contact will ensure full border

Question 4

What is the anatomy of the left lung?

Answer 4

LUL - left upper lobe LLL - left lower lobe Major fissure

Question 5

What is the anatomy of the right lung?

Answer 5

RUL RML RLL

Question 6

What happens in RML mass / consolidation?

Answer 6

The right heart border can become obscured as it is in contact with the RML therefore opacity in this will obscure the border

Question 7

Describe lung lobe and silhouette sign landmarks

Answer 7

1. RUL - Right paratrachea 2. RML - RIght heart border 3. RLL - Right hemidiaphragm 4. LUL - Aortic knuckle and left heart border 5. LLL - Left hemidiaphragm

Question 8

What is seen radiologically in emphysema?

Answer 8

• Permanent enlargement of airspaces (decreased alvealor surface for gas exchange) - loss of alveolar walls and supporting structures, reduce elastic recoil, and collapsed airways = Reduced gas exchange and air trapping in enlarged spaces 3 types - Centrilobular, panlobular, paraseptal

Question 9

What is this, and what are its notable features?

Answer 9

Emphysema - Large lung volumes - Flattened hemi-diaphragm - Horizontal ribs - Narrow mediastinum - Reduced lung markings - Barrel chest

Question 10

What is bronchiectasis?

Answer 10

Permanent dilatation of the airways secondary to chronic inflammation - Impaired bronchial clearance - destruction of lung tissues - airways widen and thicken - pathogens are retained in mucous

Question 11

Answer 11

Pneumonia

LLL collapsed

• No hemidiaphragm

Question 12

Answer 12

Technical issues

Question 13

Answer 13

Pneumothorax

Question 14

Answer 14

Cancer, Ribs matestasis (ribs 3-4)

Question 15

Answer 15

Heart Failure

Question 16

What is it? and what can cause it?

Answer 16

Enlarged pulmonary arteries

• Pulmonary arterial hypertension
• Pulmonary embolism
• Increased pulmonary blood flow
• Pregnancy
• Dilated pulmonary trunk

Question 17

What is it?

Answer 17

Pneumonia/consolidation

• RML silhouette sign

Question 18

Name these

Answer 18

1) Right paratracheal (RUL)
2) Right heart border (RML/RLL med)
3) Right hemidiaphragm (RLL)
4) Aortic knuckle (LUL)
5) Left heart border (LUL)
6) Left hemidiaphragm (LLL)

Question 19

What is this?

Answer 19

Mesothelioma of the RML/RLL

Question 20

Answer 20

Emphysema

Question 21

Answer 21

Centrilobular emphysema

Question 22

Answer 22

Panlobular emphysema

Question 23

Answer 23

Paraseptal and subpleural emphysema

Question 24

Answer 24

Asymmetrical emphysema

-

Question 25

Answer 25

Asthma,

Air trapping and bronchial wall thickening

Question 26

Answer 26

CF - Bronchiectasis

Question 27

Answer 27

CF - Bronchiectasis

Question 28